Tuesday, March 11, 2008

Gross hematuria

Well I suppose anytime you see blood in your urine it's kind of gross. Scary too. In a medicalspeak sort of way, however, gross hematuria means enough blood in urine that anyone could see it by just taking a peek before they flush. Microscopic hematuria, on the other hand, refers to hidden blood which is only found when the urine is examined under the microscope. The clearly visible sort of bloody pee is always a problem, but here's an instance where the problem was out of the ordinary.

This patient came to me doubled over in pain. He explained that he had a history of kidney stones, and had begun experiencing the typical pain from flank to groin earlier that day. The pain of kidney stones is reputed to be one of the worst pains imaginable. Sorry to be a cynic, but I felt half sympathetic AND half skeptical about the truthfulness of his story. But he brought records from another state that confirmed two previous episodes.

Most persons with a kidney stone develop microscopic hematuria, so I asked him to leave a sample of urine for analysis. He limped dramatically off to the bathroom, and emerged after awhile with a grossly bloody sample. Bright clear yellow urine shot through with strands of blood as if he might have drawn blood from his arm and squirted it into his fresh sample. I have no doubt this fellow had kidney stones in the past, and no doubt that he developed a liking of the strong narcotic pain relievers prescribed for these episodes. I invited him to head over to the ER if he was in that much pain for I was unable to help him.

Real honest-to-goodness gross hematuria is always a cause for investigation and solution. Many women have had the alarming experience of seeing blood in their urine, accompanied by the characteristic burning and urgency of a bladder infection. Some runners can bleed into their urine after extreme workouts. Otherwise, gross hematuria is quite worrisome for urological cancer and requires a careful workup.

1 comment:

Mauigirl said...

My MIL had this when she had a wicked bad bladder infection. It is now gone. The urologist wanted to do a cystoscopy but she has Alzheimer's and he wanted to put her under general anesthesia so we declined. She has not had blood in her urine since. I can't decide whether to pursue this or not.